COVID-19 Vaccination in People Living with HIV (PLWH) in China: A Cross Sectional Study of Vaccine Hesitancy, Safety, and Immunogenicity

Abstract

The administration of COVID-19 vaccines is the primary strategy used to prevent further infections by COVID-19, especially in people living with HIV (PLWH), who are at increased risk for severe symptoms and mortality. However, the vaccine hesitancy, safety, and immunogenicity of COVID-19 vaccines among PLWH have not been fully characterized. We estimated vaccine hesitancy and status of COVID-19 vaccination in Chinese PLWH, explored the safety and impact on antiviral therapy (ART) efficacy and compared the immunogenicity of an inactivated vaccine between PLWH and healthy controls (HC). In total, 27.5% (104/378) of PLWH hesitated to take the vaccine. The barriers included concerns about safety and efficacy, and physician counselling might help patients overcome this vaccine hesitancy. A COVID-19 vaccination did not cause severe side effects and had no negative impact on CD4⁺ T cell counts and HIV RNA viral load. Comparable spike receptor binding domain IgG titer were elicited in PLWH and HC after a second dose of the CoronaVac vaccine, but antibody responses were lower in poor immunological responders (CD4⁺ T cell counts < 350 cells/µL) compared with immunological responders (CD4⁺ T cell counts ≥ 350 cells/µL). These data showed that PLWH have comparable safety and immune response following inactivated COVID-19 vaccination compared with HC, but the poor immunological response in PLWH is associated with impaired humoral response.

Keywords: COVID-19; HIV; SARS-CoV-2 vaccine; immunogenicity; safety; vaccine hesitancy.

Figure 1

Flowchart of participants inclusion. PLWH: people living with HIV; HC: health control; S-RBD-IgG: spike receptor binding domain-protein specific IgG.

Figure 2

The safety and immunogenicity of COVID-19 vaccine and impact of COVID-19 vaccine on ART efficacy in PLWH. (A) Histogram demonstrating the incidence of local and systemic adverse reactions reported within 28 days after each dose of COVID-19 vaccine in PLWH (n = 219). (B) CD4⁺ T cell counts measured before and after vaccination against COVID-19 or during the same period in vaccinated PLWH (n = 219) and unvaccinated PLWH (n = 159). (C) The percentage of VL remained to be “TND” in vaccinated PLWH (n = 219) and unvaccinated PLWH (n = 159). (D) S-RBD-IgG titers after the second dose of the CoronaVac vaccine in PLWH group (n = 55) and HC group (n = 21). (E) Line plot demonstrating the dynamic trend of S-RBD-IgG titers (loess smoothed normalized counts SE) over time after the second dose of the CoronaVac vaccine in PLWH group (n = 55) and HC group (n = 21). (F) Line plot demonstrating the dynamic trend of S-RBD-IgG titers (loess smoothed normalized counts SE) over time after the second dose of the CoronaVac vaccine in immunological responders (CD4⁺ T cell counts > 350 cells/μL, n = 31) and poor immunological responders (CD4⁺ T cell counts ≤ 350 cells/μL, n = 8). (G) S-RBD-IgG titers after the second dose of the CoronaVac vaccine in immunological responders (CD4⁺ T cell counts >350 cells/μL, n = 31) and poor immunological responders (CD4⁺ T cell counts ≤ 350 cells/μL, n = 8). PLWH: people living with HIV; HC: health control; S-RBD-IgG: spike receptor binding domain-protein specific IgG.

Figure 2

The safety and immunogenicity of COVID-19 vaccine and impact of COVID-19 vaccine on ART efficacy in PLWH. (A) Histogram demonstrating the incidence of local and systemic adverse reactions reported within 28 days after each dose of COVID-19 vaccine in PLWH (n = 219). (B) CD4⁺ T cell counts measured before and after vaccination against COVID-19 or during the same period in vaccinated PLWH (n = 219) and unvaccinated PLWH (n = 159). (C) The percentage of VL remained to be “TND” in vaccinated PLWH (n = 219) and unvaccinated PLWH (n = 159). (D) S-RBD-IgG titers after the second dose of the CoronaVac vaccine in PLWH group (n = 55) and HC group (n = 21). (E) Line plot demonstrating the dynamic trend of S-RBD-IgG titers (loess smoothed normalized counts SE) over time after the second dose of the CoronaVac vaccine in PLWH group (n = 55) and HC group (n = 21). (F) Line plot demonstrating the dynamic trend of S-RBD-IgG titers (loess smoothed normalized counts SE) over time after the second dose of the CoronaVac vaccine in immunological responders (CD4⁺ T cell counts > 350 cells/μL, n = 31) and poor immunological responders (CD4⁺ T cell counts ≤ 350 cells/μL, n = 8). (G) S-RBD-IgG titers after the second dose of the CoronaVac vaccine in immunological responders (CD4⁺ T cell counts >350 cells/μL, n = 31) and poor immunological responders (CD4⁺ T cell counts ≤ 350 cells/μL, n = 8). PLWH: people living with HIV; HC: health control; S-RBD-IgG: spike receptor binding domain-protein specific IgG.